Phase III Phased Out At WCA

‘Supervised Exercise ... Covered Under Phase II’

July 21, 2013

Cardiac rehab patients at WCA Hospital may soon be looking for an alternative.

According to letters that were sent out to patients taking part in Cardiac Rehab Phase III services, due to a lack of recognition and support for the program through Medicare, Medicaid and the Medical Liability Mutual Insurance Company, the program will be coming to an end. Phase I and Phase II services, however, will be maintained at WCA. If there's a special condition that would require patients to continue with closely supervised rehabilitation, they can continue in Phase II of the program. There are, however, strict medical necessity regulations that determine who qualifies.

"In review of our program by our insurance carrier, there seemed to be more patients in cardiac rehab than would traditionally be in a rehab program," said Larry Senns, vice president of administration. "We started looking at it and looking at who really is using our facility more as a fitness facility or a gym that could be exercising elsewhere."

Article Photos

WCA?Hospital may end its Phase III cardiac rehabilitation services.P-J photo by Ryan Atkins

According to Senns, at any given time, there are between 67 and 74 people who come and go from the program. Many of those patients have been in the rehab program for a length of time, and those are the ones who will be most likely to transition to a different phase.

"When a person has a cardiac event, they're often in the hospital, and the rehab program begins there," Senns said. "After they're discharged, it continues as outpatient rehab, which we call Phase II. Insurance generally covers 36 rehab sessions for a patient in Phase II, but the program has a beginning and an end."

As part of the requirements for Phase II rehab, there are physicians on-site, as well as trained cardiac nurses, and patients are monitored closely. One of the primary goals of the program is to explain to patients how they can keep from having another cardiac event through maintaining their diet, proper communication with their physician on symptoms and understanding the issues that they face.

"Really the goal of rehab is to help the patient understand what they're going through, reduce the risk of recurrence and transition them into self-maintenance and self-exercise to maintain their own health," Senns said. "Our goal is always to work with patients to achieve their highest potential and transition them to independent living."

Phase III of the cardiac rehab program is considered "late recovery." This is the portion of the program where patients begin to integrate back into home or exercise at other facilities, according to Senns.

"In the traditional Phase III program, through our insurance carrier, we identified that there may be folks still in the program who don't meet the medical necessity to be exercising at the hospital," Senns said. "They could exercise independently at another facility, instead. We're working with every single patient to identify the best transition into a community or home program. We're also working on determining if any patients have a special condition that would require supervised exercise, which would be covered under Phase II of the program."

There are some facilities in the greater Jamestown area that have organized membership or wellness programs where people with all sorts of physical conditions can continue to exercise under supervision. Medicare and some commercial insurances even cover membership at area fitness facilities. Senns says that the ultimate goal of WCA in this aspect is to encourage people to be more proactive about preventing heart disease, as well as spending more time working on educating the public about cardiac health.

"There are a number of exercise facilities in the area, both private and public, that our patients can use," Senns said. "Many people walk at the Jamestown Savings Bank Arena or outside. Part of the rehab process is to help them understand what is safe. We want to make sure in the future people understand what they need to do in order to stay healthy."

In the rehab program, patients typically take part in exercises including walking on treadmills, using exercise bikes, weight training and rowing machines. In rehab, the patients are also closely monitored.

"Those that are clearly able to transition, we're transitioning as quickly and as smoothly as possible," Senns said. "We need to set a goal for when the program will officially end, but part of transitioning is that people need time. Hopefully those folks will transition this week, then we'll continue to individually assess other folks if there's a question whether they can transition."